Wednesday, September 30, 2009

Southern Baptist Convention: Politics trump morality

Unbelievably (or not), considering Richard Land's history, this position on health reform:

In his August 18, 209 press release, Dr. Land states that he opposes the current House bill, H.R. 3200, but does believe that health care reform is needed.
According to Land, he "recognize[s] the need to rework certain elements of the health care equation in America. While the health care industry in the U.S. is relatively robust, it is not without flaws. And there is a segment of the American population, either because of their income level or their medical condition, that needs responsible and well-regulated government assistance."
Dr. Land doesn't believe that greater government involvement is the answer. Dr. Land believes that tort reform is one of the biggest avenues of savings in the health care industry. He states, "If we had tort reform, just tort reform, getting the stinking, rotten lawyers out of the business of ambulance chasing, we would eliminate about $50 billion of medical costs every year that doctors have to pay for malpractice insurance which is then passed on to you in the form of bills."
Dr. Land does believe that in a country as prosperous as the United States, every one should have guaranteed access to some level of health care, though he rejects government involvement. According to Land, the "answer is to provide alternatives and incentives for most people to be in health care that they provide for themselves, and then the government can focus like a laser on those who aren't able to provide it for themselves and you give them a basic level of health care. If I could use the car analogy, everybody should have a Chevrolet. Those who can afford it can get Cadillacs or even Mercedes."
It is amazing that Mr. Land's SBC seems to have more in common philisophically with Ayn Rand than Jesus Christ. Or the Pope.

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Monday, September 28, 2009

Altmire on Public Option

This is from Firedoglake

List of Blue Dogs who have expressed support for a public option (with Nate Silver's estimate of district support/opposition in parenthesis):

1. Jason Altmire: (35-53)

Signed HCAN principles

July 17: Voted 'no' as a member of the Health & Labor Committee against 3200 because of wealth surtax.

September 11: 'I - I'm speaking for myself, I think that the public option may, if it's done correctly may be a part of the package and could play a role. As Congresswoman Woolsey described, it would have to airtight, completely self-sustaining, not funded through taxpayer subsidies, and have to meet all the same insurance regulations. So, I don't think that is the sticking point for the Blue Dogs and the moderate members. I think what we are most concerned about is we have to do this in a fiscally responsible way.'

September 22: 'Altmire's chief complaint about his own chamber's bill was the inclusion of a surtax on the wealthy. But he said he didn't expect that provision to make it through, and he signaled that excluding it would allow him to vote for the final bill.'

It looks like we in Western PA have some work to do in getting Altmire's district turned around. Those are abysmal numbers of support for the Public Option.

Sounds like a job for Doctors for America.

If you would like a doctor to come speak in Mr. Altmire's district, please let me know and I will do it or find someone who will!

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Wednesday, September 23, 2009

Hospitalists' Take on Baucus Bill

From The Hospitalist Web site

Addition of a hospital value-based purchasing (VBP) program to Medicare beginning in 2012. The program would tie incentive payments to performance on quality measures related to such conditions as heart failure, pneumonia, surgical care, and patient perceptions of care. So far, the program’s rough outlines have been well received. “We fundamentally support hospital value-based purchasing,” Dr. Siegal says. “We think it’s a necessary step in the evolution to higher-value health care in general.”

Expansion of the Physician’s Quality Reporting Initiative, with a 1% payment penalty by 2012 for nonparticipants. The bill also would direct the Centers for Medicare and Medicaid Services (CMS) to improve the appeals process and feedback mechanism. Although the Baucus plan’s “mark” doesn’t discuss transitioning to pay-for-performance, Dr. Siegal says the shift likely is inevitable. In the meantime, pay-for-reporting can encourage better outcomes through a public reporting mechanism and “grease the skids” for a pay-for-performance initiative.

Creation of a CMS Payment Innovation Center “authorized to test, evaluate, and expand different payment structures and methodologies,” with a goal of improving quality and reducing Medicare costs. Dr. Siegal says the proposal is consistent with SHM’s aims. “We have for a long time advocated for a robust capability to test new payment models and to figure out what works better than what we have right now,” he says.

Establishment of a three-year Medicare pilot called the Community Care Transitions Program. The program would spend $500 million over 10years on efforts to reduce preventable rehospitalizations. SHM’s Project BOOST (Better Outcomes for Older Adults through Safe Transitions) likely would qualify. “We’re very positive about that,” Dr. Siegal says. “I think there is a huge amount of scrutiny now on avoidable rehospitalizations. We think BOOST is a step in the right direction, and we’d love to see greater funding to roll this out on a much larger basis.”

For more information on the current healthcare reform debate, visit SHM’s advocacy portal.

Bryn Nelson wrote the piece for The Hospitalist, and Eric Siegal, MD, is chair of the Society of Hospital Medicine's Public Policy Committee.

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Sunday, September 20, 2009

The Health Care System Under French National Health Insurance: Lessons for Health Reform in the United States -- Rodwin 93 (1): 31 -- American Journal of Public Health

The Health Care System Under French National Health Insurance: Lessons for Health Reform in the United States -- Rodwin 93 (1): 31 -- American Journal of Public Health:

Keepin' it real. Every system comes with trade-offs...

THE FRENCH HEALTH CARE system has achieved sudden notoriety since it was ranked No. 1 by the World Health Organization in 2000.1 Although the methodology used by this assessment has been criticized in the Journal and elsewhere,2–5 indicators of overall satisfaction and health status support the view that France’s health care system, while not the best according to these criteria, is impressive and deserves attention by anyone interested in rekindling health care reform in the United States (Table 1). French politicians have defended their health system as an ideal synthesis of solidarity and liberalism (a term understood in much of Europe to mean market-based economic systems), lying between Britain’s 'nationalized' health service, where there is too much rationing, and the United States’ 'competitive' system, where too many people have no health insurance. This view, however, is tempered by more sober analysts who argue that excessive centralization of decisionmaking and chronic deficits incurred by French national health insurance (NHI) require significant reform.

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Tuesday, September 15, 2009

Tort Reform does not necessarily equal caps

From the AMA.

Tort reform may still be coming, per President Obama's Address last week. While caps are still the AMA's favorite remedy, in this recent letter they outline some other considerations...

Alternative Reforms

While the AMA continues to advocate for proven reforms like MICRA, we are also committed to finding innovative solutions to the broken medical liability system such as offering of grants tostates to pursue alternatives to current tort litigation. These alternatives include:

• Health Courts. Health courts would provide a forum where medical liability actions could be heard by judges specially trained in medical liability matters and who hear only medical liability cases. The AMA developed and adopted health court principles in 2007 to assist state and local governments, insurers, hospitals and other entities interested in exploring this option for medical liability reform.
• Early Disclosure and Compensation Programs. Under an early disclosure and compensation model, providers would be required to notify a patient of an adverse event within a limited period of time. Notification does not constitute an admission of
liability. Providers offering to compensate for injuries in good faith would be provided immunity from liability. Payments for non-economic damages would be based on a defined payment schedule developed by the state in consultation with relevant experts and with the Secretary of Health and Human Services (HHS).
• Administrative Determination of Compensation Model. A state’s administrative entity would be charged with setting a compensation schedule for injuries, resolving claims for injuries, and establishing compensation based on the patient’s net economic loss, subject to periodic payment and offset by collateral payments from sources such as insurance.
• Expert Witness Qualifications. Several states have amended the statutory qualifications for those who may serve as medical expert witnesses at trial. Some states (e.g., Georgia, Texas, and Illinois) have created additional standards that medical expert witnesses must meet in order to ensure the testimony juries receive is presented by an individual with particularized expertise in the matter in question.

The AMA is committed to finding a solution to the challenges of the broken medical liability system, including federal reforms based on proven state solutions like California and Texas as well as alternative liability reforms like health courts. The AMA also supports protecting patients’ access to care by working in concert with
state medical associations to enact and defend strong medical liability reform laws.

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Broken healthcare and broken lives - DFA's Alex Blum

Broken healthcare and broken lives -

In the middle of one night during my training at a county hospital outside of Los Angeles, a 12-year-old boy arrived at the emergency room. He was having a seizure. From a brain scan, we made the terrible diagnosis: He had suffered a massive stroke. At best, he would be severely disabled for the rest of his life.

When I sat down with his mother to tell her the bad news, she told me that he had been a happy, healthy child through most of grade school. But there had been one other trip to the hospital. When he was 7, he'd had a stroke from which he recovered quickly and completely. His mother had been instructed to take him to a specialist to find out what was wrong so he would not have another stroke. But she was the family's sole provider and simply could not afford the expensive out-of-pocket bills.

At first I was shocked and angry to learn she ignored a physician's advice that could have prevented this tragedy. I quickly realized, though, that the true culprit was our broken healthcare system. Because this system denies millions of Americans access to care, my patient's mother was forced to take a gamble on her child's health. The result was a debilitating stroke that should have been prevented.

Until the system changes, health catastrophes like this will continue to be commonplace in America. Until we reform the system, Americans will continue to be forced to choose between feeding their families and taking them to the doctor.

From Doctors for America's Alex Blum...

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Saturday, September 12, 2009

The Most Outrageous U.S. Lies About Global Healthcare | Foreign Policy

The Most Outrageous U.S. Lies About Global Healthcare Foreign Policy

As the U.S. Congress this summer holds its first serious health-care reform debate since the Clinton era, the resulting public furor has featured increasingly overheated claims about everything from so-called "death panels" to the supposed prowess of America's homegrown medicine. Many of the most wildly inaccurate statements have been directed abroad -- sometimes at the United States' closest allies, such as Britain and Canada, and often at the best health-care systems in the world.

The lies rebutted include:

1. Stephen Hawking and Ted Kennedy would be doomed outside the US.
2. Canadians come to the US for urgent care.
3. All European health care systems are single payer.
4. Canada and Britain restrict health care choices.
5. The US has The Best Healthcare In The World. (TM)

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Thursday, September 10, 2009

The Ayn Randers and HC Reform

I was on a couple web sites today, the Mayo Clinic Health Policy Center's and Ezra Klein's, and looking at the comments is so disheartening. That people who consider themselves good people (Christians, secular humanists, whatever) can swallow the Ayn Rand crap and not have their heads explode from the cognitive dissonance is amazing.

One particular line of attack that disgusted me was this smug argument that food is necessary for life, why don't we have national food insurance or some similar drivel.

My response on Ezra's blog:

The difference between food and health care is several orders of magnitude.

I don't see patients in my ICU beds due to lack of food, but due to lack of access to care. People rarely lose their homes, their cars, or file for bankruptcy due to food costs.

We have, as a nation, decided to help those in hunger with food stamps, WIC and other programs, we decided in 1965 that allowing the elderly to die and suffer without access to health care was no longer acceptable, and in 1935, we decided allowing the elderly to really suffer in poverty and hunger was not acceptable.

We are the only modern nation that still seems to believe, based upon our lack of action, that our poor do not deserve access to good quality health care on at least a comparable footing with the rest of us.
Go find a physician or a nurse and have a laugh with them with your comparison. Nearly all will be aghast at your callousness. You will find some who support you, but their numbers are thankfully dwindling. Those in the leadership of medicine KNOW that we must advocate for high quality health care for all Americans, not just those who can afford it.

I've compiled a list of physicians organizations advocating for health care, to give you an idea of how cold your statements are to those of us in the front lines actually taking care of those "undeserving sick."

And some anecdotes for you and your friends to have a laugh about.

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Wednesday, September 9, 2009

Robert Reich Explains the Public Option - Concisely

Thanks to Firedoglake for this link! Robert Reich does an excellent job of explaining the public opition in under 3 minutes...

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Tuesday, September 8, 2009

Organized Medicine on Reform

***Update: Now 8 of the 10 largest organizations are on board!***

Welcome to the blog. To make this a bit easier for everyone, here are the physician organizations FOR either HB 3200 or something close to it: AMA, AOA, ACP, AAFP, ACOG, ACS, AAP, ACC, AGA, ASCO, and SHM.

Squishy middle: AAO, AAOS, ACEP

Mo' money, then we'll talk: ASA, ACR.

Details below...

The American Medical Association, ~240K members:

[After passage of HB 3200 out of committee -cmhmd]... the American Medical Association sent a letter to House leaders supporting H.R. 3200, "America's Affordable Health Choices Act of 2009." "This legislation includes a broad range of provisions that are key to effective, comprehensive health system reform," said J. James Rohack, MD, AMA president. "We urge the House committees of jurisdiction to pass the bill for consideration by the full House." H.R. 3200 includes provisions key to effective, comprehensive health reform, including:

  • Coverage to all Americans through health insurance market reforms
  • A choice of plans through a health insurance exchange
  • An end to coverage denials based on pre-existing conditions
  • Fundamental Medicare reform, including repeal of the flawed sustainable growth rate (SGR) formula
  • Additional funding for primary care services, without reductions on specialty care
  • Individual responsibility for health insurance, including premium assistance to those who need it
  • Prevention and wellness initiatives to help keep Americans healthy
  • Initiatives to address physician workforce concerns
"The status quo is unacceptable," Dr. Rohack said. "We support passage of H.R. 3200, and we look forward to additional constructive dialogue as the long process of passing a health reform bill continues."

The American Osteopathic Association ("represents" 67K, per their website; not clear if this is actual membership)

Why is the AOA supporting H.R. 3200?
The “America’s Affordable Health Choices Act” (H.R. 3200) contains several provisions that reflect AOA priorities forhealth system reform. These priorities include: expanding the availability of affordable health care coverage to the uninsured, increased support for prevention and wellness services, investments in the physician workforce, increased Medicare payments for primary care services without cutting payments for other services and, importantly, it represents our best hope for eliminating the current sustainable growth rate (SGR) formula for updating Medicare physician payments. The AOA continues to work with members of the House of Representatives to improve the bill by seeking additions and changes in the legislation. Specifically, we are working to include expanded graduate medical education provisions, medical liability reform, and student loan financing reforms. Favorable action on a House bill is necessary to move the process to the end game negotiations that will determine the specifics of a final bill.

American College of Physicians (ACP, represents 126 K internal medicine physicians including primary care and medical subspecialists like me):

H.R. 3200 does much of what ACP asked Congress to do in terms of coverage, support for the primary care workforce, payment and delivery system reform, based on long-standing policies that have been adopted by this organization. No bill is perfect, but H.R. 3200 delivers on our major priorities in a way that is remarkably consistent with ACP policies, policies that were developed by the College's leadership over many years and always guide how ACP’s leadership, Key Contacts and staff advocate for internal medicine physicians and their patients.

American Academy of Family Physicians, 94K members:

On behalf of the 94,600 members of the American Academy of Family Physicians, thank you for the positive steps you have taken toward broader, affordable coverage that will mean improved health care based on primary care. We believe that the America’s Affordable Health Choices Act (H.R. 3200) will make significant progress toward payment and delivery system reforms and contribute to building a primary care workforce for the future. AAFP supports this legislation and we will be pleased to work with your committees to improve it further.
The public plan option developed by your committees reflects most of these principles very well.

American Academy of Pediatrics, 60 K members:

“The American Academy of Pediatrics (AAP), which represents 60,000 pediatricians, pediatric medical subspecialists, and surgical specialists, praises the U.S. House Energy and Commerce Committee for its vote today on H.R. 3200, America’s Affordable Health Choices Act, and applauds all three House Committees for their continued and steadfast work in the effort to pass significant health care reform.
“The Academy continues to support the process of bringing comprehensive health care reform to America’s children. While there is still work to be done, H.R. 3200 makes significant progress in achieving the Academy’s priorities of covering all children in the United States, providing children with age-appropriate benefits in a medical home, and establishing appropriate payment rates to guarantee children have access to covered services.

American College of Surgeons, 76 K members:

They have a letter of support for HR 3200, but you can't copy and paste... maybe a little gun-shy about letting the membership see it!

American College of Obstetrics and Gynecology, 52 K members:

"ACOG President Gerald F. Joseph, Jr. MD provides ACOG endorsement of HR3200 (proposed America's Affordable Health Choices Act of 2009)."

[The rest is behind a password protected section.]

American Academy of Ophthalmology, 7 K members:

Have not yet taken a position on any specific bill, but:

Meanwhile, the Academy, AMA and the American College of Surgeons have been up on the Hill pushing medicine and ophthalmology’s agenda. The Senate bill is expected to contain a rate-setting commission proposal that the Academy helped defeat in the House bill and other troublesome provisions affecting medicine and surgery.


Acknowledging that the status quo in health care is unsustainable and that issues of access to coverage, quality of care and cost control must be addressed, and given legislative momentum in Congress, the Academy is advancing components for bills that protect patients and physicians. While reform discussions are still ongoing and no pending legislation is perfect, we are committed to continue collaborating with health leaders in Congress to improve bills being considered. The Academy is actively engaged with other physician organizations as key House and Senate committees debate legislation that puts a long-term sustainable growth rate (SGR) fix in play, in addition to other top issues.

American Association of Orthopedic Surgeons, ~17 K members:

The AAOS is committed to ensuring that the final bill be as beneficial as possible to the Orthopaedic community, including our patients. We will not make any decisions in support or opposition until something closer to a final bill is available.

Ooops! Perhaps phrased poorly!

American College of Cardiology, 37 K members:

On behalf of the American College of Cardiology (ACC), representing 37,000 cardiovascular members, I am writing to commend you for H.R. 3200, the "America’s Affordable Health Choices Act of 2009.” This legislation makes a significant financial commitment to comprehensive health system reform and we are committed to working with you on this effort.
ACC is especially pleased that H.R. 3200 takes extraordinary measures to extend coverage to every American and takes positive steps to strengthen Medicare. Among the Medicare provisions the College supports include:
• Funding to eliminate the accumulated debt from the flawed Sustainable Growth Rate (SGR);
• Establishment of a positive Medicare physician payment update (MEI) for 2010
and favorable spending targets for updates in the future;
• Significant payment and delivery reform models such as incentives for physicians to participate in Accountable Care Organizations; and
• Expansion and improvements to the Physician Quality Reporting Initiative (PQRI) to encourage successful participation;

American Society of Clinical Oncology:
Can't find anything on their website. The American Cancer Society, on the other hand, has made access to health care via serious reform their top priority. And, by the way, on palliative care? They're for it.

American Gastroenterological Association, 17 K members:

On behalf of the American Gastroenterological Association (AGA), representing over 17,000 physicians and scientists who research, diagnose and treat disorders of the gastrointestinal tract and liver, I am writing to express our appreciation and support for several provisions in H.R. 3200, America’s Affordable Health Choices Act. The AGA appreciates your leadership and shares in your goal to expand health care coverage to the uninsured, improve coordination of care, and enhance quality.

American College of Emergency Physicians, 27 K members:

"It is important to note, however, that a common theme supported by members of the House and Senate (Democrats and Republicans), as well as the White House, is to extend coverage to nearly all Americans, although there are differences of opinion as to how this objective is best achieved. ACEP supports this endeavor to provide universal health care as a benefit for patients and its outcome of drastically reducing the burden of uncompensated care provided by emergency physicians.
ACEP encourages you to discuss and promote these issues with your members of Congress during the August recess. Your message to lawmakers:
These provisions will improve your constituents' access to vital emergency medical care services and they must be part of the final health care reform package that is sent to President Obama.
Due to the fragmented, unpredictable nature of the process, and the lack of a final product in the House or Senate, ACEP has refrained from taking a public position on the overall legislative proposals. This has been, and remains, a very fluid process and we want to assure you that ACEP will continue to monitor these plans and advocate
for the needs of emergency physicians and your patients."

American Society of Anesthesiology, 43 K members:

"ASA members may be confused by a request for support of H.R. 3200 by other medical associations, including most recently the AMA. ASA CANNOT AND WILL NOT SUPPORT THE BILL IN ITS CURRENT FORM. Members are strongly encouraged NOT to respond to AMA’s request to support H.R. 3200. The bill, the ‘America’s Affordable Health Choices Act,’ includes a public plan option based upon Medicare payment rates for anesthesia services. A Medicare rate-based public plan would be detrimental to the medical specialty of anesthesiology.

“ASA has consistently urged lawmakers to address anesthesiology’s ‘33 percent problem’: the fact that Medicare pays 33 percent of what private insurers pay for anesthesia services (while Medicare pays an average of 80 percent of what private insurers pay for most other medical specialties). This 33 percent payment level simply does not reflect the costs of providing anesthesiology medical care. As such, Congress must not use this payment level as a model for any health care plan.

“We acknowledge that there are many laudable provisions included in H.R. 3200. Still, many issues remain unresolved, and questions linger about how various provisions would impact anesthesiology. We must remember that there is no other organization involved in the reform debate that is speaking for anesthesiology. In fact, some groups are actively lobbying for provisions that would harm our specialty. Anesthesiologists’ shared voice is the only way to ensure that the important and unique concerns of our specialty, our practices and our patients are heard in the halls of Congress. "

American College of Radiology, 32 K members:

Best I could find on their website:

Unfortunately, it seems ACRs position regarding the House version of healthcare reform, HR 3200, has been incorrectly characterized. As many of the details of overall health care legislation remain fluid, the College has not taken a position, for
or against, any of the current overall congressional proposals, including HR 3200.
Regarding HR 3200, we continue to educate congressional leaders that the imaging and radiation therapy provisions, including a raise in the equipment utilization rate assumption to 75 percent and a further 25 percent cut to contiguous imaging, are flawed ideas that will ultimately harm patient access to care particularly in rural areas.
Until negotiations regarding such provisions are complete or are clearly at an impasse, ACR will not take an official position on the entire House bill. Any information that ACR has offered its support or opposition to HR 3200 is incorrect.

Update: I almost forgot to include some rather contrarian sentiments from the South Carolina Medical Association, as well as some "Old School" conservative physicians to round out the round up. They are not alone, as some other deeply red states' Medical Societies have expressed similar dire warnings. But for them, this is really about ideology, not solutions.

Update II:

Society of Hospital Medicine ( ~6 K members, represents hospital based physicians):

On behalf of the Society of Hospital Medicine (SHM), I am writing to express our support for provisions in H.R. 3200, the “America’s Affordable Health Choices Act of 2009” regarding delivery system reform. SHM represents the nation’s hospitalists—physicians whose primary professional focus is the general medical care and management of hospitalized patients. We agree that the time has come for comprehensive health reform and appreciate your leadership and commitment in pursuit of this worthy goal.

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Tuesday, September 1, 2009

Daily Kos: A few anecdotes about medical care in America...

Daily Kos: A few anecdotes about medical care in America...

I posted this on DailyKos tonight. Please go read the rest and chime in!

On many levels, I hate to venture into anecdote territory when it comes to health care reform. I don't think it informs the debate in a helpful manner, and yet, it seems to be one of the two major arms of the conservative campaign against health care reform. First, they argue, look how awful it is everywhere else and how wonderful we have it here in America with THE Best Health Care System in the World (TM) and second, they find even Medicare, Social Security and unemployment benefits ideological anathema.

I can't do anything about the second one, but I do have something to
say about the first.

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